NPIMap

Individual provider Active NPI

Susan E Paytash, PA

  • Medical Physician Assistant
  • Boise, ID
National Provider Identifier
1912073370
Registry record updated Feb 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA596 Issued in ID
Practice address
1673 W Shoreline Dr
Suite 120
Boise, ID 83702-6749
Phone
(208) 367-8383
Fax
(208) 429-8310
NPI assigned
Nov 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA596 ID Primary
Medical Physician Assistant 363AM0700X PA-596 ID

Addresses

Primary practice location

1673 W Shoreline Dr
Suite 120
Boise, ID 83702-6749

Mailing address

3340 E Goldstone Way
Meridian, ID 83642-1026
Phone (208) 367-5170

Other identifiers 1

IdentifierTypeStateIssuer
807392700MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060322000217 ID Practitioner - Physician Assistant 6507874203 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Saint Alphonsus Regional Medical Center IncGroup PAC ID 3476462359, 672 clinicians

Practice addresses (Care Compare)

2141 E Parkcenter Blvd
Boise, ID 83706-6701
Phone (208) 302-5000

3025 W Cherry LN
Meridian, ID 83642-8531

Hospital & facility affiliations

  • Enhabit Home Health & Hospice Home health agency, Boise, ID, CCN 137006
  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007
  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA-596IDMDMedical Physician Assistant
PA596IDMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Dec 22, 2009 Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Dec 22, 2009 Accepting new patients

Locations

1055 N Curtis Rd
Boise, ID 83706
Phone (208) 367-2152

2141 E Parkcenter Blvd
Boise, ID 83706
Phone (208) 302-5000

1673 W Shoreline Dr
Ste 120
Boise, ID 83702
Phone (208) 367-8383

315 E Elm St
Ste 100
Caldwell, ID 83605
Phone (208) 302-7100

3340 E Goldstone Dr
Meridian, ID 83642
Phone (208) 302-9342

3025 W Cherry Ln
Meridian, ID 83642
Phone (208) 302-6400

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

1512 12th Ave Rd
Nampa, ID 83686
Phone (208) 463-5000

Interoperability endpoints

  • Direct secure messaging: spaytash1564099@direct.trinity-health.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361318400000",
    "number": "1912073370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 E GOLDSTONE WAY",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421026",
            "telephone_number": "208-367-5170",
            "fax_number": "208-367-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1673 W SHORELINE DR",
            "address_2": "SUITE 120",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026749",
            "telephone_number": "208-367-8383",
            "fax_number": "208-429-8310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAYTASH",
        "first_name": "SUSAN",
        "middle_name": "E",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-28",
        "last_updated": "2013-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA596",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA-596",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807392700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.